Moderate aortic stenosis in the dysfunctional ventricle: should it be treated?

Abstract

Moderate aortic stenosis is associated with a worse prognosis than milder degrees. Pathophysiologically, this condition in a dysfunctional ventricle could lead to a further mechanism of haemodynamic worsening, so its treatment should lead to clinical advantages for the patient. The low risk of complications associated with percutaneous correction of aortic valve disease (transcatheter aortic valve implantation) should also be considered, which would seem to favour an interventional approach even in the aforementioned condition. However, sparse data and small population studies make this approach still controversial. Three randomized controlled trials are underway to shed definitive light on the topic.

Keywords: HFrEF; Heart failure; Low flow–low gradient; Moderate aortic stenosis; TAVI.

Figure 1

Long-term survival adjusted for severity of aortic stenosis. Adapted from Strange et al.

Figure 2

Cumulative incidence of adverse outcome in patients with heart failure with reduced ejection fraction with or without moderate aortic stenosis. Adapted from Jean et al. Left: all-cause mortality. Right: hospitalization for heart failure or all-cause mortality. *Adjusted for age, sex, body mass index, diabetes, hypertension, previous myocardial infarction, dyslipidaemia, ischaemic heart disease, New York Heart Association functional classes III to IV, renal filtration rate, greater than mild aortic regurgitation, greater than mild mitral regurgitation, and left ventricular ejection fraction.